AlphaMED Resources · https://alphamedicine.uk/Resources/cases/alzheimers-drugs
Alzheimer's drugs and NHS funding
Lecanemab and donanemab slow the decline in early Alzheimer's disease, but NICE has refused to fund them because the benefit is too small for the cost. The companies appealed, and in July 2026 NICE paused its reviews while they negotiate with NHS England.
- Lecanemab licensed in the UK, donanemab in October
- NICE final draft rejects both drugs
- Eisai and Eli Lilly appeal hearings
- Appeals partly upheld and a third draft published
- NICE pauses both reviews for commercial talks
Summary
- Lecanemab and donanemab are infusions for early Alzheimer's disease, which damages memory and thinking. They are made by Eisai and Eli Lilly, and the MHRA has licensed them for people without two copies of the ApoE4 gene (lecanemab, donanemab).
- The problem is cost. NICE accepts that the drugs delay the move from mild to moderate Alzheimer's by four to six months, which matters to patients and carers. But it judges that gain too small for the price.
- NICE's final draft guidance of 19 June 2025 rejected both drugs. Both companies appealed, and on 20 March 2026 the appeal panels upheld parts of each, so NICE must look again.
- NICE published a third draft on 31 March 2026, and its committee discussed the appeal points on 8 July 2026.
- On 29 and 30 July 2026 NICE paused both reviews while the companies and NHS England talk commercially. Neither drug is recommended for NHS use.
Dig deeper
- The benefit is disputed. In donanemab's main trial, the CDR SB score, a standard clinical rating, fell 0.70 points less than placebo at 76 weeks, a slowing of 29 per cent. NICE's draft says the effect at 18 months "may be about half" the smallest meaningful change.
- The appeal panels sent both back on how carers' quality of life is valued. Eisai said NICE had seriously underestimated the burden on carers. Alzheimer's Society welcomed the review of "the significant impact of dementia on unpaid carers".
- Monitoring is heavy. Lecanemab is infused every two weeks and donanemab every four, with MRI scans. In donanemab's main trial, 24.0% of patients had ARIA, swelling in the brain seen on scan, against 2.1% on placebo, and 52 of the 205 cases had symptoms.
- The cost test. NICE's March 2026 draft said an acceptable cost is around £20,000 per quality adjusted life year. Its plausible estimate for donanemab was about £69,000. In December 2025 the government agreed that NICE will apply £25,000 to £35,000 per QALY.
- Casgevy, a gene therapy for sickle cell disease, also arrived with a very high list price. NICE recommended it with managed access after a confidential discount.
Ethical issues
| Principle | How it applies here |
|---|---|
| Autonomy | Adults are presumed to have capacity, so the choice to start treatment is the patient's, if they understand the risk of ARIA. Where the NHS does not fund the drug, only those who can pay can choose it. |
| Beneficence | A few months' slower decline could keep someone independent for longer and reduce family care. NICE has not been persuaded that the benefit justifies the cost. |
| Non maleficence | ARIA is swelling and potential bleeding in the brain, found on MRI. Avoiding it takes scans and infusion monitoring, which is part of what makes the treatment costly. |
| Justice | NICE says funding could displace other essential treatments. But the drugs are open now only to those who can pay, and a UK Dementia Research Institute researcher has warned of "greater inequities". |
Interview questions
- What do you know about the NICE decisions on lecanemab and donanemab?
- What did the appeal panels decide, and when?
- A patient's daughter asks whether she should pay privately for donanemab for her father. What do you tell her?
- Why might a drug that slows decline for a few months still fail a cost test?
- What is the case for and against the NHS refusing a drug that patients and carers want, when its budget is limited?
- What is ARIA, and what should the NHS do about it?
- Should a patient who can pay be able to buy a drug the NHS does not fund?
- How should NICE weigh the time unpaid carers spend on a patient against the cost to the NHS?
Sources
- NICEnice.org.uk/…/gid-ta11220
- NICEnice.org.uk/…/gid-ta11221
- GOV.UKgov.uk/…/lecanemab-licensed-for-adult-patients-in-the-early-stages-of
- GOV.UKgov.uk/…/donanemab-licensed-for-early-stages-of-alzheimers-disease-in
- NICEnice.org.uk/…/the-benefits-of-alzheimers-treatments-donanemab-and-lecanema
- NICEnice.org.uk/…/draft-guidance-3
- NICEnice.org.uk/…/appeal-decision
- pharmaceutical-journal.compharmaceutical-journal.com/…/nice-opens-consultation-on-previously-rejected-alzheimers-tr
- pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov/…/37459141
- GOV.UKgov.uk/…/landmark-uk-us-pharmaceuticals-deal-to-safeguard-medicines-a
- NICEnice.org.uk/…/ta1044
- pharmaceutical-journal.compharmaceutical-journal.com/…/everything-you-need-to-know-about-nices-decisions-on-game-ch
Photo: Klunkwe, CC BY-SA 3.0, via Wikimedia Commons, colour altered.
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